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Related to GM-CSF: interleukin, Cytokines, Sargramostim
Pharmacologic class: Granulocytemacrophage colony stimulating factor
Therapeutic class: Hematopoietic agent
Pregnancy risk category C
Stimulates proliferation and differentiation of hematopoietic cells that activate mature granulocytes and macrophages of target cells
Liquid: 500 mcg/ml
Powder for injection: 250 mcg
⊘Indications and dosages
➣ Post peripheral blood progenitor cell (PBPC) transplantation
Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, starting immediately after progenitor cell infusion
➣ Mobilization of PBPCs into peripheral blood for collection by leukapheresis
Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, continued throughout harvesting
➣ Neutrophil recovery after chemotherapy in acute myelogenous leukemia Adults: 250 mcg/m2/day I.V. over 4 hours, starting 4 days after completion of chemotherapy induction
➣ Bone-marrow transplantation failure or engraftment delay
Adults: 250 mcg/m2/day as 2-hour I.V. infusion for 14 days. If engraftment doesn't occur, may repeat after 7 days of drug hiatus.
➣ Myeloid reconstitution after autologous or allogeneic bone-marrow transplantation
Adults: 250 mcg/m2/day as a 2-hour I.V. infusion, starting 2 to 4 hours after autologous bone marrow infusion and at least 24 hours after last chemotherapy or radiotherapy dose
• Crohn's disease
• Wound healing
• Vaccine adjuvant
• Hypersensitivity to drug, its components, or yeast products
• Excessive leukemic myeloid blasts in bone marrow or peripheral blood (10% or more)
• Within 24 hours before or after chemotherapy or radiation therapy
Use cautiously in:
• renal or hepatic insufficiency, fluid retention, pulmonary disorders, pulmonary infiltrates, heart failure, leukocytosis, transient supraventricular arrhythmias
• cancer patients undergoing sargramostim-mobilized PBPC collection
• patients receiving purged bone marrow or previously exposed to intensive chemotherapy or radiation therapy
• pregnant or breastfeeding patients
☞ Don't give within 24 hours of chemotherapy or radiation therapy.
• Add 1 ml of sterile water to powder for injection by directing water stream against side of vial and swirling vial gently to disperse contents.
• Avoid shaking or agitating solution.
• For a final drug concentration below 10 mcg/ml, add human albumin 0.1% to saline solution; then dilute drug in normal saline solution.
• Infuse as soon as possible after reconstitution, but no more than 6 hours after mixing.
• Don't add other drugs to infusion; don't use in-line filter.
CNS: malaise, asthenia
CV: peripheral edema, tachycardia, hypotension, transient supraventricular tachycardia, pericardial effusion
GI: nausea, vomiting, diarrhea, anorexia, stomatitis, GI hemorrhage
GU: urinary tract disorder, abnormal renal function
Hematologic: blood dyscrasias, hemorrhage
Hepatic: hepatic damage
Musculoskeletal: joint pain, myalgia, bone pain
Respiratory: dyspnea, lung disorder
Skin: rash, alopecia
Other: fever, chills, sepsis, edema, first-dose reaction (respiratory distress, hypoxia, syncope, tachycardia, hypotension, flushing)
Drug-drug.Corticosteroids, lithium: potentiation of myeloproliferative effects
Vincristine: severe peripheral neuropathy
• Monitor for dyspnea. Halve dosage and contact prescriber if dyspnea occurs.
• Assess CBC with white cell differential. Check for presence of blast cells, and watch for signs and symptoms of blood dyscrasias.
• Closely monitor vital signs and fluid intake and output. Stay alert for signs and symptoms of fluid overload.
☞ Monitor liver function tests, and watch for evidence of hepatic damage and bleeding (especially GI hemorrhage).
☞ Tell patient sargramostim is a powerful drug that can cause significant adverse reactions. Teach him to recognize and report serious reactions at once.
☞ Instruct patient to immediately report unusual bleeding or bruising or yellowing of skin or eyes.
• Tell patient drug may cause weakness and musculoskeletal pain.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.
GM-CSFgranulocyte-macrophage colony-stimulating factor.
CSF2A gene on chromosome 5q23-q31 that encodes colony stimulating factor 2 (granulocyte-macrophage), a cytokine that controls the production, differentiation and function of granulocytes and macrophages.
CSF2 is localised to a cluster of related genes at chromosome 5q31, a region associated with deletions in the 5q- syndrome and acute myelogenous leukaemia.